A place for a tired old woman to try to figure things out so that the world makes a bit of sense.

Monday, November 28, 2005

The Battle to Cut Medicaid

Congressional Democrats are finding an usual foe in the battle over Medicaid cuts: Democratic governors. As the Washington Post points out, governors of both parties face the daunting task of working within their budgets when Medicaid's state costs keep rising so dramatically.

Controversial House legislation designed to gain control of Medicaid growth has split Democrats, with lawmakers in Washington united in their opposition while Democratic governors are quietly supporting the provisions and questioning the party's reflexive denunciations.

The Medicaid provisions have become a flashpoint for the opposition of Democrats -- and some moderate Republicans -- to the $50 billion budget-cutting bill that narrowly passed the House last week. The provisions would reduce Medicaid spending by $12 billion through 2010 and $48 billion over the next decade, in part by making it difficult for more affluent seniors to transfer their assets to relatives, then plead poverty to get Medicaid to pay for them to stay in nursing homes.

But the measures would also save $2.4 billion over five years by allowing state governments to impose higher health insurance deductibles, co-payments and premiums on poor Medicaid recipients, including, for the first time, impoverished children and pregnant women. An additional $3.9 billion would be saved by relaxing mandated preventive health care and screening of children and pregnant women.

..."As the number of people without health insurance has increased for four years in a row, Republicans are charging ahead with $45 billion in cuts to Medicaid -- the health insurance program that provides medical care to America's poorest children and many of the survivors of Hurricane Katrina," House Minority Leader Nancy Pelosi (D-Calif.) thundered Nov. 18, just before the pre-dawn passage of the bill. "Republicans give new meaning to the words 'suffer little children.' "

What she did not say is that those changes were proposed over the summer by a bipartisan task force of governors, led by Virginia's Mark R. Warner, whose popularity in a Republican state has made him a rising star in the Democratic Party.

...For governors, the soaring costs of Medicaid threaten to swamp state financing. Already, tens of thousands of people have been thrown off the Medicaid rolls in states such as Tennessee and Missouri, and governors have warned that those cuts will grow deeper if they do not have the flexibility to trim benefits more rationally.

The division stems in part from long-standing fears that if Washington gives states too much latitude over federal programs, some governors will go too far. Under the House bill, the $3 co-payment for Medicaid recipients below the poverty level would be allowed to rise annually with the medical inflation rate. For the first time, states would be allowed to refuse care for patients who refuse to pay.

States would also be allowed to charge co-payments, premiums or deductibles for visits to hospital emergency rooms for non-emergency care and for expensive prescription drugs not on a list of preferred medications.

What really worries liberal policy groups is a measure allowing states to impose any co-payment they want on Medicaid recipients who are above the poverty line, typically the working poor. Those fees are supposed to remain below 5 percent of beneficiaries' total incomes, but policy experts say that cap will be impossible to enforce. Most working poor will not be able to track their annual medical expenses to that degree of specificity. [Emphasis added]

Of course, a substantial savings will come from those recipients who won't seek medical treatment because they can't afford the co-payment. Routine health care will be gone without until a condition becomes so serious that a visit to the local ER is the only course available.

With fewer employers providing health care benefits, more Americans are going uninsured or under-insured because they cannot afford private policies. Until this country finally comes to grips with its failed health care system and develops a new single payer system akin to Medicare, medical costs will continue to soar and states will continue to plan the rest of their budgets around Medicaid.

The answer is not less Medicaid, but more. This nation needs to start developing a better health care system and stop cutting taxes for those who don't need them.